If you are a carer to someone with a spinal cord injury, you should know about a serious medical condition called autonomic dysreflexia, so you can help to prevent and possibly resolve it.
If you’re the carer of somebody with a spinal cord injury, you should know about autonomic dysreflexia (AD) – a serious and potentially life-threatening condition.
Your role as a carer is particularly important, since some of the common symptoms of autonomic dysreflexia may impair the mental capacity of the person under your care. These include a debilitating headache and a feeling of disorientation or confusion. Therefore, he or she may not be able to recognise or deal with what’s happening in their body, which can lead to a stroke, seizure or cardiac arrest.
Understanding autonomic dysreflexia: the basics
Autonomic dysreflexia happens when the body’s autonomic nervous system is “confused” and overreacts to stimuli below the level of the spinal cord injury. Blood pressure spikes and heart rate slows – a lethal combination. Many causes can send the body into this dangerous spiral.
Not all people with spinal cord injuries are vulnerable to autonomic dysreflexia. If the spinal cord injury is T6 or above, the person under your care is at high risk. If the injury location is between T-6 and T-10, there is a moderate risk of AD. A spinal cord injury below T10 eliminates the risk.
Carer tips to help prevent autonomic dysreflexia
There are a wide variety of stimuli below the level of the spinal cord injury that can trigger the onset of autonomic dysreflexia. These triggers also vary in terms of the type of pain, discomfort or stimulation. It can be something as minor as tight-fitting clothing or something major, like a broken bone or a deep cut. A trigger might be a full bladder, or it could be sexual activity.
As a career, it’s vital that you understand the typical causes. This information is helpful not only for the prevention of autonomic dysreflexia, but also in potentially resolving the condition without going to A&E (but always err on the side of caution).
Three areas frequently trigger autonomic dysreflexia, with bladder problems being the number one cause. You’ll find some carer tips for preventing AD in the following table.
|
Common AD Problem Area |
Carer Prevention Tips |
|
Bladder issues |
· Check several times a day that the catheter bag isn’t overfilled /Check several times a day that the catheter bag isn’t overfull. · Make sure catheter hoses are not kinked or blocked /Make sure that catheter hoses are not kinked or blocked. · Inspect the catheter for damage, loose connections, or a possible malfunction; replace or fix, if needed /Inspect the catheter for damage, loose connections or a possible malfunction; replace or fix if necessary. · If an intermittent catheter is being used, make sure to stick to a daily schedule and that the bladder is emptied fully each time /If an intermittent catheter is being used, make sure that you stick to a daily routine and that the bladder is emptied fully each time. · Look for signs of a urinary tract infection /Look for signs of a urinary tract infection. |
|
Bowel problems |
· Help address and resolve any constipation issues with the person under your care; consult a physician, if needed /Help address and resolve any constipation issues with the person under your care; consult a doctor if necessary. · If you supervise or assist with digital stimulation, make sure it is done gently and with enough lubricant /If you supervise or assist with digital stimulation, ensure that it is done gently and with enough lubricant. · Check for hemorrhoids and help minimize or reduce them with ointments and cushions; arrange medical attention, if needed /Check for haemorrhoids and help to minimise or reduce them with ointments and cushions; arrange medical attention if necessary. · Take notice of excessive gas, bloating, or flatulence; address with diet changes or consult with your medical team /Take note of any excessive gas, bloating or flatulence; address this with diet changes or consult your medical team. · Recognize the symptoms of a bowel infection —diarrhea, changes in stool appearance, rectal bleeding, vomiting; if you spot any of these signs, arrange for a doctor’s visit /Recognise the symptoms of a bowel infection – diarrhoea, changes in stool appearance, rectal bleeding, vomiting; if you spot any of these signs, arrange for a doctor’s visit. |
|
Skin or skin-related issues |
· Check for pressure sores (pressure ulcers); stay vigilant in avoiding pressure wound injuries by consistently making sure the person under your care changes body position frequently, keeps the skin clean, stays hydrated, and does pressure releases every 15-20 minutes; consult your medical team for more pressure injury prevention tips / Check for pressure sores (pressure ulcers); stay vigilant in avoiding pressure wound injuries by consistently making sure that the person under your care changes body position frequently, keeps their skin clean, stays hydrated and does pressure releases every 15-20 minutes; consult your medical team for more pressure injury prevention tips. · Regularly look for red spots, blisters, scrapes, insect bites, or cuts /Regularly examine for red spots, blisters, scrapes, insect bites or cuts. · Be aware of any hard or sharp objects pressing against the skin /Be aware of any hard or sharp objects pressing against the skin. · Make sure wheelchair cushions are placed properly and inflated fully /Make sure that wheelchair cushions are placed properly and inflated. |
Caregivers—when to seek medical help
You know some of the potential “hot spots” and what you can do to prevent AD. This knowledge helps to resolve issues if this medical condition does arise suddenly. For instance, you can quickly act to unkink a catheter hose or change an overfull bag – two very common causes.
If you suspect that the person under your care is experiencing autonomic dysreflexia, check their blood pressure every five minutes. (Carers should have access to a home blood pressure monitor and know how to use it.) If the injury is above T6, often a reading of 20-40 mm Hg above baseline may be a sign of AD. In adolescents, a reading of 15-20 mm Hg above baseline signals possible AD. In children, a reading of 15 mm Hg above baseline potentially indicates AD.
If the warning signs and symptoms of autonomic dysreflexia persist, you should treat it as a medical emergency and immediately go to your nearest A&E.
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